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des Bordes U, Hoang T, Dale BS, Sharma AK. Sclerotherapy of the Post renal Transplant Lymphoceles: A Meta-Analysis. Transplant Proc 2024; 56:316-321. [PMID: 38368131 DOI: 10.1016/j.transproceed.2024.01.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 01/16/2024] [Indexed: 02/19/2024]
Abstract
PURPOSE This study evaluated the effectiveness of sclerotherapy in treating lymphoceles after kidney transplantation, focusing on factors such as recurrence rates and procedural success. MATERIALS AND METHODS Retrospective studies using sclerotherapy as the only form of treatment for postrenal transplant lymphoceles were included. All studies used percutaneous transcatheter sclerotherapy as treatment, and the success rate of the intervention was recorded. Sixty-one references were obtained by manually searching the MEDLINE (n = 20), Embase (n = 41), and Cochrane Library databases (n = 0) for retrospective research studies that included the keywords "sclerotherapy post renal transplant lymphoceles." After removing 3 duplicates, 50 of the remaining articles were excluded after the screening, and the remaining studies were extracted for demographic data and our primary outcome of the success rate of sclerotherapy. RESULTS A descriptive analysis of the outcomes and complication rates associated with sclerotherapy interventions for lymphoceles is provided. A high degree of variation across the different studies was observed. According to the Kruskal-Wallis test, there was no correlation between the sclerosant used and the sclerotherapy complication rate (P = .472) or the success rate (P = .591). There was also no correlation between the gender of the patient and the success rate; however, there was a significant difference in the complication rate by gender (P < .005). CONCLUSIONS In conclusion, different sclerosant products have been used for therapy with no consensus on the most efficacious product because the success rate has been variable. In addition, the gender of the patient may influence the complication rates associated with sclerotherapy for lymphoceles in patients post-kidney transplant.
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Affiliation(s)
- Ursula des Bordes
- Department of Internal Medicine, University of Rochester, Rochester, New York
| | | | - Benjamin S Dale
- Department of Surgery, University of Rochester, Rochester, New York
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Kashiwagi E, Ono Y, Yano H, Kosai S, Nagai K, Tanaka K, Higashihara H, Tomiyama N. Percutaneous sclerotherapy with OK-432 for lymphocele after pelvic or para-aortic lymphadenectomy: preliminary results. CVIR Endovasc 2022; 5:55. [PMID: 36264442 PMCID: PMC9584008 DOI: 10.1186/s42155-022-00332-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/14/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Lymphoceles can result from disruption of lymphatic vessels after surgical procedures in areas with extensive lymphatic networks. Percutaneous catheter drainage with sclerotherapy can be performed for the treatment of lymphoceles. OK-432 has been used to treat benign cysts, such as lymphangioma and ranula. Therefore, we aimed to report the efficacy and safety of sclerotherapy using OK-432 for postoperative lymphoceles. This study retrospectively analyzed 16 patients who underwent sclerotherapy using OK-432 for postoperative pelvic and para-aortic lymphoceles between April 1, 2012, and March 31, 2020. All the patients underwent percutaneous drainage before sclerotherapy. The indications for sclerotherapy were persistent drainage tube output of greater than 50 mL per day and recurrent lymphoceles after percutaneous drainage. If less than 20 mL per day was drained after sclerotherapy, the tube was removed. When the drainage tube output did not decrease to less than 20 mL per day after the first sclerotherapy, the second sclerotherapy was performed 1 week later. Technical success was defined as the completion of drainage and sclerotherapy procedures. Clinical success was defined as the resolution of the patient's symptoms resulting from lymphoceles without surgical intervention. This study also evaluated the complications of sclerotherapy and their progress after sclerotherapy. RESULTS The mean initial lymphocele size and drainage duration after sclerotherapy were 616 mL and 7.1 days, respectively. The technical success rate and clinical success rate were 100% and 93%, respectively. Thirteen patients were treated by one-session sclerotherapy and three patients were treated by two-session sclerotherapy. Minor complications (fever) were observed in eight patients (50%). A major complication (small bowel fistula) was observed in one patient (7%). No recurrence of lymphoceles was observed during the mean follow-up period of 17 months. CONCLUSION Sclerotherapy with OK-432 is an effective therapeutic method for postoperative lymphoceles. Although most complications are minor, a small bowel fistula was observed in one patient.
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Affiliation(s)
- Eiji Kashiwagi
- grid.136593.b0000 0004 0373 3971Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Yusuke Ono
- grid.136593.b0000 0004 0373 3971Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Hiroki Yano
- grid.136593.b0000 0004 0373 3971Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Shinya Kosai
- grid.136593.b0000 0004 0373 3971Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Keisuke Nagai
- grid.136593.b0000 0004 0373 3971Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Kaishu Tanaka
- grid.136593.b0000 0004 0373 3971Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Hiroki Higashihara
- grid.136593.b0000 0004 0373 3971Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Noriyuki Tomiyama
- grid.136593.b0000 0004 0373 3971Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
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Schneider G, Ourfali S, Rouviere O, Pagnoux G, Colombel M. Lymphatic embolization for the management of symptomatic pelvic lymphocele after radical prostatectomy with lymph node dissection: Report of two cases. IJU Case Rep 2021; 4:5-9. [PMID: 33426486 PMCID: PMC7784736 DOI: 10.1002/iju5.12212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/15/2020] [Accepted: 07/20/2020] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Pelvic lymphocele is the most common complication of pelvic lymph node dissection after radical prostatectomy. Management of symptomatic pelvic lymphocele begins with percutaneous drainage, followed by sclerotherapy or surgical marsupialization and more recently, lymphatic embolization. In this article, we show the feasibility and results of two lymphatic embolization after prostatectomy with lymph node dissection. CASE PRESENTATION We decided to perform lymphatic embolization in two patients with persistent symptomatic pelvic lymphocele, after percutaneous drainage. This was done through inguinal lymph node puncture using Lipiodol and N-butyl cyanoacrylate glue injection. Drainage removal was done on the day after the procedure and clinical recovery was maintained at follow-up visits, 3 and 4 months later, in both patients. Computed tomography at 6 and 10 weeks after embolization showed the disappearance of the lymphocele. CONCLUSION Our two case reports support the promising results of lymphatic embolization in this pathology.
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Affiliation(s)
- Gregoire Schneider
- Urologic Surgery and Transplantation DepartmentHôpital Edouard HerriotHospices Civils de LyonLyonFrance
| | - Said Ourfali
- Urologic Surgery and Transplantation DepartmentHôpital Edouard HerriotHospices Civils de LyonLyonFrance
- Université Lyon 1 Faculté de Médecine Lyon EstUniversité de LyonLyonFrance
| | - Olivier Rouviere
- Department of UroradiologyHôpital Edouard HerriotHospices Civils de LyonLyonFrance
- Université Lyon 1 Faculté de Médecine Lyon EstUniversité de LyonLyonFrance
| | - Gaele Pagnoux
- Department of UroradiologyHôpital Edouard HerriotHospices Civils de LyonLyonFrance
| | - Marc Colombel
- Urologic Surgery and Transplantation DepartmentHôpital Edouard HerriotHospices Civils de LyonLyonFrance
- Université Lyon 1 Faculté de Médecine Lyon EstUniversité de LyonLyonFrance
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Treatment of symptomatic postoperative pelvic lymphoceles: A systematic review. Eur J Radiol 2020; 134:109459. [PMID: 33302026 DOI: 10.1016/j.ejrad.2020.109459] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/10/2020] [Accepted: 11/30/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE A broad range of therapeutic options exists for symptomatic postoperative lymphoceles. However, no consensus exists on what is the optimal therapy. In this study, we aimed to compare the efficacy of currently available radiologic interventions in terms of number of successful interventions, number of recurrences, and number of complications. METHODS A systematic review was conducted with a pre-defined search strategy for PubMed, EMBASE, and Cochrane databases from inception until September 2019. Quality assessment was performed using the 'Risk Of Bias In Non-randomized Studies - of Interventions' tool. Statistical heterogeneity was assessed using the I2 and χ2 test and a meta-analysis was considered for studies reporting on multiple interventions. RESULTS 37 eligible studies including 732 lymphoceles were identified. Proportions of successful interventions for percutaneous fine needle aspiration, percutaneous catheter drainage, percutaneous catheter drainage with delayed or instantaneous addition of sclerotherapy, and embolization were as follows: 0.341 (95% confidence interval [CI]: 0.185-0.542), 0.612 (95% CI: 0.490-0.722), 0.890 (95% CI: 0.781-0.948), 0.872 (95% CI: 0.710-0.949), 0.922 (95% CI: 0.731-0.981). Random-effects meta-analysis of seven studies revealed a pooled relative risk for percutaneous catheter drainage with delayed addition of sclerotherapy of 1.57 (95% CI: 1.17-2.10) when compared to percutaneous catheter drainage alone. The risk of bias in this study was severe. CONCLUSIONS This systematic review demonstrates that the success rates of percutaneous catheter drainage with sclerotherapy are more favorable when compared to percutaneous catheter drainage alone in the treatment of postoperative pelvic lymphoceles. Overall, percutaneous catheter drainage with delayed addition of sclerotherapy, and embolization showed the best outcomes.
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Povidone-iodine sclerotherapy of primary symptomatic lymphocele after kidney transplantation. Int Urol Nephrol 2020; 53:685-690. [PMID: 33170487 DOI: 10.1007/s11255-020-02709-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/03/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To report the efficacy and safety of povidone-iodine sclerotherapy of primary symptomatic lymphocele after kidney transplantation in a large contemporary cohort study. PATIENTS AND METHODS A single-institutional study was conducted including consecutive patients who underwent povidone-iodine sclerotherapy for primary symptomatic lymphocele after kidney transplantation between January 2013 and March 2020. Sclerotherapy was used as the first-line treatment of symptomatic lymphocele. Recurrent lymphoceles were managed with open or laparoscopic fenestration. The primary outcome was the efficacy of sclerotherapy which was defined as the absence of second sclerotherapy or salvage surgery. RESULTS A total of 965 renal transplantations were included. Sclerotherapy for primary symptomatic lymphocele was performed in 60 cases (6.2%). The median (IQR) number of instillation, the volume of povidone-iodine per instillation and drainage time were 3 (3-3), 60 (38-80) mL and 6 days (5-8), respectively. Sclerotherapy related complications were reported in eight cases (13.3%) and included five cases of accidental catheter removal, two cases of lumbosciatica, and one case of intraperitoneal diffusion of povidone-iodine. After a median (IQR) follow-up of 33 (14-60) months, treatment success was achieved in 33 cases (55%). Multivariate analysis failed to identify predictors of sclerotherapy failure. Salvage therapies included 7 s sclerotherapy and 20 surgical fenestrations with an overall success rate of 88.8% (24/27). CONCLUSIONS Sclerotherapy was an easy and safe procedure to treat primary symptomatic lymphocele in renal transplant recipients. Despite moderate efficacy, recurrences were easily controlled with salvage therapies. Further studies are necessary to identify predictive factors of sclerotherapy failure to directly refer patients to surgical treatment.
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Mehrabi A, Kulu Y, Sabagh M, Khajeh E, Mohammadi S, Ghamarnejad O, Golriz M, Morath C, Bechstein WO, Berlakovich GA, Demartines N, Duran M, Fischer L, Gürke L, Klempnauer J, Königsrainer A, Lang H, Neumann UP, Pascher A, Paul A, Pisarski P, Pratschke J, Schneeberger S, Settmacher U, Viebahn R, Wirth M, Wullich B, Zeier M, Büchler MW. Consensus on definition and severity grading of lymphatic complications after kidney transplantation. Br J Surg 2020; 107:801-811. [PMID: 32227483 DOI: 10.1002/bjs.11587] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/23/2020] [Accepted: 02/14/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The incidence of lymphatic complications after kidney transplantation varies considerably in the literature. This is partly because a universally accepted definition has not been established. This study aimed to propose an acceptable definition and severity grading system for lymphatic complications based on their management strategy. METHODS Relevant literature published in MEDLINE and Web of Science was searched systematically. A consensus for definition and a severity grading was then sought between 20 high-volume transplant centres. RESULTS Lymphorrhoea/lymphocele was defined in 32 of 87 included studies. Sixty-three articles explained how lymphatic complications were managed, but none graded their severity. The proposed definition of lymphorrhoea was leakage of more than 50 ml fluid (not urine, blood or pus) per day from the drain, or the drain site after removal of the drain, for more than 1 week after kidney transplantation. The proposed definition of lymphocele was a fluid collection of any size near to the transplanted kidney, after urinoma, haematoma and abscess have been excluded. Grade A lymphatic complications have a minor and/or non-invasive impact on the clinical management of the patient; grade B complications require non-surgical intervention; and grade C complications require invasive surgical intervention. CONCLUSION A clear definition and severity grading for lymphatic complications after kidney transplantation was agreed. The proposed definitions should allow better comparisons between studies.
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Affiliation(s)
- A Mehrabi
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Y Kulu
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - M Sabagh
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - E Khajeh
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - S Mohammadi
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - O Ghamarnejad
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - M Golriz
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - C Morath
- Division of Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - W O Bechstein
- Department of General and Visceral Surgery, Frankfurt University Hospital, Goethe University, Frankfurt am Main, Germany
| | - G A Berlakovich
- Division of Transplantation, Department of Surgery, Vienna Medical University, Vienna, Austria
| | - N Demartines
- Department of Visceral Surgery, CHUV University Hospital, Lausanne, Switzerland
| | - M Duran
- Department of Vascular and Endovascular Surgery, Düsseldorf University Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - L Fischer
- Department of Visceral and Transplantation Surgery, Hamburg-Eppendorf University Hospital, Hamburg, Germany
| | - L Gürke
- Department of Vascular and Transplantation Surgery, Basel University Hospital, Basel, Switzerland
| | - J Klempnauer
- Department of General, Visceral, and Transplantation Surgery, Hannover Medical University, Hannover, Germany
| | - A Königsrainer
- Department of General, Visceral and Transplantation Surgery, Eberhard-Karls-University Hospital, Tübingen, Germany
| | - H Lang
- Department of General, Visceral and Transplantation Surgery, Johannes Gutenberg Medical University, Mainz, Germany
| | - U P Neumann
- Department of General, Visceral and Transplantation Surgery, RWTH University Hospital, Aachen, Germany
| | - A Pascher
- Department of General, Visceral and Transplantation Surgery, Münster University Hospital, Münster, Germany
| | - A Paul
- Department of General, Visceral and Transplantation Surgery, Essen University Hospital, Essen, Germany
| | - P Pisarski
- Department of General, Visceral and Surgery, Freiburg University Hospital, Freiburg, Germany
| | - J Pratschke
- Department of Surgery, Charité University Hospital, Berlin, Germany
| | - S Schneeberger
- Department of Visceral, Transplantation and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - U Settmacher
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany
| | - R Viebahn
- Department of Surgery, Knappschaftskrankenhaus University Hospital of Bochum, Ruhr University of Bochum, Bochum, Germany
| | - M Wirth
- Department of Urology, Carl Gustav Carus University Hospital, Dresden, Germany
| | - B Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany
| | - M Zeier
- Division of Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - M W Büchler
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
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Pal D, Roy P, Chatterjee A, Jana D, Mandal D. The role of povidone-iodine in prevention of lymphorrhea after kidney transplant surgery - A prospective, pilot study. INDIAN JOURNAL OF TRANSPLANTATION 2020. [DOI: 10.4103/ijot.ijot_96_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sureka SK, Yadav P, Singh UP, Lal H, Kapoor R, Ansari MS, Srivastava A. Role of early povidone iodine instillation in post-renal transplant lymphorrhea: A prospective randomized study. Turk J Urol 2019; 45:461-466. [PMID: 31603421 DOI: 10.5152/tud.2019.88137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 03/01/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of the present study was to prospectively evaluate the role of early povidone iodine instillation in the management of post-renal transplant lymphorrhea. MATERIAL AND METHODS Live-related renal transplant recipients operated between January 2002 and December 2015 were included in the study. Significant lymphorrhea was defined as >50 mL lymph from drain beyond postoperative day 5. Such patients were randomized into two groups by simple randomization using a computer-generated random list: group A (received 0.5% povidone iodine instillation) and group B (no instillation). Absolute risk reduction and numbers needed to treat were calculated to estimate the effect of povidone iodine instillation for the treatment of lymphorrhea and decrease in the incidence of lymphocoele. RESULTS A total of 1766 patients underwent renal transplant during this period. One hundred seventeen patients with lymphorrhea through the drain underwent randomization into group A (n=61) and group B (n=56). In group A, 58 patients had successful resolution within 2 weeks, whereas in group B, 34 patients had successful resolution within 2 weeks. Overall, 9 (14.75%) patients in group A and 29 (51.78%) patients in group B had lymphatic collections (both symptomatic and asymptomatic). Symptomatic lymphocoele was present in 1 patient in group A and 7 patients in group B on follow-up. Absolute risk reduction was 10.8%, and for every symptomatic lymphocoele prevented, 10 patients needed povidone iodine instillation. CONCLUSION Povidone iodine instillation after 5 days of transplantation aids in the early resolution of post-renal transplantation lymphorrhea, as well as reduces the incidence of future lymphocoele.
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Affiliation(s)
- Sanjoy K Sureka
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Priyank Yadav
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Uday Pratap Singh
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Hira Lal
- Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Rakesh Kapoor
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Mohd S Ansari
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Aneesh Srivastava
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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Jain R, Wairkar S. Recent developments and clinical applications of surgical glues: An overview. Int J Biol Macromol 2019; 137:95-106. [DOI: 10.1016/j.ijbiomac.2019.06.208] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/21/2019] [Accepted: 06/26/2019] [Indexed: 01/10/2023]
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A Novel Technique in the Treatment of Lymphoceles After Renal Transplantation: C-Arm Cone Beam CT-Guided Percutaneous Embolization of Lymphatic Leakage After Lymphangiography. Transplantation 2019; 102:1955-1960. [PMID: 29757895 DOI: 10.1097/tp.0000000000002268] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND We aimed to evaluate the efficacy of percutaneous embolization after lymphangiography using C-arm cone-beam computed tomography (CBCT) performed at the site of lymphatic leakage in patients with postrenal transplant lymphocele. METHODS Between July 2014 and August 2017, 13 patients not responding to percutaneous ethanol sclerotherapy and conservative treatment for recurrent lymphocele after renal transplant were included. The mean age of the patients was 56.38 ± 9.91 (range, 36-70) years, and it comprised 9 men and 4 women. All patients underwent intranodal lymphangiography. C-arm CBCT-guided percutaneous embolization was performed in patients with confirmed lymphatic leakage. Patients who had no lymphatic leakage underwent drainage with fibrin glue injection. RESULTS Lymphatic leakage was observed in 9 patients after lymphangiography, and they underwent CBCT-guided percutaneous N-butyl-2-cyanoacrylate embolization. The volume of lymphatic drainage reduced to less than 10 mL in 8 patients. One patient who was not responding to embolization was treated surgically, after percutaneous drainage and fibrin glue injection. Lymphatic leakage was not observed in 4 patients after lymphangiography. Of these, 3 patients showed a reduction in the amount of lymphatic drainage after lymphangiography. All 4 patients underwent percutaneous drainage and fibrin glue injection. One patient did not respond to the treatment and was treated surgically. Prelymphangiography and postlymphangiography and embolization, the volume of lymphatic drainage was 113.07 ± 21.75 mL, and 53.84 ± 30.96 mL, respectively, and statistically significant decrease was detected (P < 0.005). CONCLUSIONS Lymphangiography and CBCT-guided percutaneous embolization procedures might be an effective treatment method for patients with lymphocele refractory to treatment.
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Tsaur I, Thomas C. Risk factors, complications and management of lymphocele formation after radical prostatectomy: A mini-review. Int J Urol 2019; 26:711-716. [PMID: 30939628 DOI: 10.1111/iju.13964] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 03/18/2019] [Indexed: 12/01/2022]
Abstract
Lymphocele formation is the most common adverse event of pelvic lymphadenectomy during radical prostatectomy for prostate cancer. Previous studies failed to favor one surgical technique over the other in terms of minimizing its rate. Data on risk factors for its development are still conflicting and warranting further research. In this mini-review, we aimed to scrutinize available evidence on these aspects and outline current achievements in lymphocele prevention approaches.
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Affiliation(s)
- Igor Tsaur
- Department of Urology and Pediatric Urology, Mainz University Medical Center, Mainz, Germany
| | - Christian Thomas
- Department of Urology, University Hospital Dresden, Dresden, Germany
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Chu HH, Shin JH, Kim JW, Noh SY, Yang WJ, Park S. Lymphangiography and Lymphatic Embolization for the Management of Pelvic Lymphocele After Radical Prostatectomy in Prostatic Cancer. Cardiovasc Intervent Radiol 2019; 42:873-879. [PMID: 30919025 DOI: 10.1007/s00270-019-02209-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 03/18/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To retrospectively evaluate the short-term outcomes of lymphangiography and lymphatic embolization in the treatment of pelvic lymphocele after radical prostatectomy in patients with prostate cancer. MATERIALS AND METHODS The data of nine, consecutive patients who underwent lymphangiography and lymphatic embolization for pelvic lymphocele after radical prostatectomy with pelvic lymph node dissection (PLND) between January 2016 and May 2018, were retrospectively reviewed. Lymphangiography was performed through inguinal lymph nodes in order to identify the lymphatic leakage. When a leakage was found, lymphatic embolization was performed using a directly punctured fine needle at the closest upstream lymph node or lymphopseudoaneurysm and with N-butyl cyanoacrylate glue. RESULTS Lymphangiography demonstrated extravasation and/or lymphopseudoaneurysm in all of these patients. A total of 13 sessions of lymphangiography and lymphatic embolization were performed. The median number of lymphangiography and lymphatic embolizations required to achieve clinical success was one (range, 1-3). Three patients underwent repeated embolization with successful results. The technical and clinical success rates were 100%, respectively. The median time to resolution was 7 days (range, 2-19 days). There was no recurrence and no procedure-related complications during the follow-up period (mean, 26 weeks; range, 8-77 weeks) in all patients. CONCLUSIONS Lymphangiography and lymphatic embolization are safe and effective for the management of pelvic lymphoceles after radical prostatectomy with PLND.
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Affiliation(s)
- Hee Ho Chu
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| | - Jong Woo Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Seung Yeon Noh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Woo Jin Yang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Suyoung Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
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Nerli R, Sushant D, Ghagane S, Nutalpati S, Mohan S, Dixit N, Neelagund S, Hiremath M. Lymphocele complications following renal transplantation. INDIAN JOURNAL OF TRANSPLANTATION 2019. [DOI: 10.4103/ijot.ijot_33_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Nishibeppu K, Arita T, Nakanishi M, Kuriu Y, Murayama Y, Shoda K, Kosuga T, Konishi H, Morimura R, Komatsu S, Shiozaki A, Ikoma H, Ichikawa D, Fujiwara H, Okamoto K, Otsuji E. A successful case of a para-aortic lymphocele treated with autologous peripheral blood injection. Radiol Case Rep 2018; 12:760-763. [PMID: 29484065 PMCID: PMC5823392 DOI: 10.1016/j.radcr.2017.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/27/2017] [Accepted: 08/28/2017] [Indexed: 11/03/2022] Open
Abstract
A lymphocele is one of the complications of systematic pelvic or para-aortic lymphadenectomy. Although most patients are entirely asymptomatic, our patient exhibited an obstructive ileus at the jejunum compressed by a lymphocele. We report here a case of a subsequent para-aortic lymphocele treated with autologous peripheral blood injection. A 68-year-old woman with sigmoid colon cancer (T3N2bM1a) underwent laparoscopic sigmoidectomy. After 4 courses of chemotherapy (CapeOX + Bmab), para-aortic lymphadenectomy was additionally performed. One month later, an obstructive ileus occurred suddenly due to a lymphocele. A drainage catheter was placed into the lymphocele and a total of 35 mL of autologous peripheral blood was injected in 4 divided doses through the catheter. The volume of the lymphocele gradually reduced and the ileus improved after blood injection. This is the first report of a successful case of a subsequent para-aortic lymphocele treated with autologous peripheral blood injection without any complications.
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Affiliation(s)
- Keiji Nishibeppu
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, Kyoto, Japan
| | - Tomohiro Arita
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, Kyoto, Japan
| | - Masayoshi Nakanishi
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, Kyoto, Japan
| | - Yoshiaki Kuriu
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, Kyoto, Japan
| | - Yasutoshi Murayama
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, Kyoto, Japan
| | - Katsutoshi Shoda
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, Kyoto, Japan
| | - Toshiyuki Kosuga
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, Kyoto, Japan
| | - Hirotaka Konishi
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, Kyoto, Japan
| | - Ryo Morimura
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, Kyoto, Japan
| | - Shuhei Komatsu
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, Kyoto, Japan
| | - Atsushi Shiozaki
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, Kyoto, Japan
| | - Hisashi Ikoma
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, Kyoto, Japan
| | - Daisuke Ichikawa
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, Kyoto, Japan
| | - Hitoshi Fujiwara
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, Kyoto, Japan
| | - Kazuma Okamoto
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, Kyoto, Japan
| | - Eigo Otsuji
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, Kyoto, Japan
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15
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Pucheril D, Campbell L, Bauer RM, Montorsi F, Sammon JD, Schlomm T. A Clinician's Guide to Avoiding and Managing Common Complications During and After Robot-assisted Laparoscopic Radical Prostatectomy. Eur Urol Focus 2016; 2:30-48. [PMID: 28723448 DOI: 10.1016/j.euf.2016.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/23/2016] [Accepted: 03/25/2016] [Indexed: 01/21/2023]
Abstract
CONTEXT Robot-assisted radical prostatectomy (RARP) is on the advance globally, and it is essential for surgeons and patients to know the rates of perioperative complications. OBJECTIVE To provide evidence-based clinical guidance on avoiding and managing common complications during and after RARP in the context of a comprehensive literature review. EVIDENCE ACQUISITION In concordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis 2015 statement guidelines, a literature search of the PubMed database from August 1, 2011, to August 31, 2015, using the predefined search terms robot* AND radical prostatectomy, was conducted. The search resulted in 653 unique results that were subsequently uploaded to DistillerSR (Evidence Partners, Ottawa, Canada) for team-based screening and processing of references. EVIDENCE SYNTHESIS Overall, 37 studies met the inclusion criteria and were included. Median rate of overall complication was 12.6% (range: 3.1-42%). Most of the complications were minor (Clavien-Dindo grades 1 and 2). Grade 3 complications comprised the bulk of the major complications with a median rate of 2.7%; grade IV and V complications were exceedingly rare in all reports. CONCLUSIONS Despite continued adoption of the RARP technique globally, rates of overall complication remain low. Many of the complications experienced during and after RARP can be mitigated and prevented by experience and the implementation of safe techniques. PATIENT SUMMARY Despite continued adoption of the robot-assisted radical prostatectomy (RARP) technique globally, rates of overall and major complications remain low at 12.6% and 2.7%, respectively. Complications can be minimized and successfully managed using established techniques. RARP is a safe and reproducible technique.
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Affiliation(s)
- Daniel Pucheril
- VUI Center for Outcomes Research, Analytics and Evaluation, Detroit, MI, USA.
| | - Logan Campbell
- VUI Center for Outcomes Research, Analytics and Evaluation, Detroit, MI, USA
| | - Ricarda M Bauer
- Department of Urology, Ludwig Maximilian University, Munich, Germany
| | - Francesco Montorsi
- Department of Urology, University Vita-Salute San Raffaele, Milan, Italy
| | - Jesse D Sammon
- VUI Center for Outcomes Research, Analytics and Evaluation, Detroit, MI, USA
| | - Thorsten Schlomm
- Martini-Klinik, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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16
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Presser N, Kerr H, Gao T, Begala M, Paschal S, Shoskes DA, Flechner SM. Fibrin Glue Injections: A Minimally Invasive and Cost-Effective Treatment for Post-Renal Transplant Lymphoceles and Lymph Fistulas. Am J Transplant 2016; 16:694-9. [PMID: 26461049 DOI: 10.1111/ajt.13470] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 07/21/2015] [Accepted: 07/21/2015] [Indexed: 01/25/2023]
Abstract
Pelvic lymphoceles/lymph fistulas are commonly observed after kidney allotransplantation, especially when the kidney is placed in a retroperitoneal position. While the majority are <5 cm in diameter and resolve without intervention, some may continue to enlarge, and cause local or systemic symptoms or graft dysfunction. Among 1662 recipients of both living and deceased donor kidney transplants between January 2003 and July 2014, we found 46 (2.7%) patients with symptomatic lymphoceles requiring intervention. We studied the clinical outcomes and charges for three treatment modalities including open surgical drainage (22), laparoscopic surgical drainage (11), and percutaneous fibrin glue injections into the drained lymphocele cavity (13). The patient demographics and clinical characteristics were comparable for each treatment group, although maintenance immunosuppressive drugs differed by era. We found fibrin glue injections resulted in significantly lower (p = 0.04) rates of recurrence (1; 7.7%) than either laparoscopic (6; 54%) or open surgical drainage (6; 27.3%). In addition, fibrin glue injections generated significantly (p < 0.001) lower median ($4559) charges compared to either laparoscopic ($26,330) or open surgical drainage ($23,758). Fibrin glue treatment has the advantage of being an outpatient procedure, performed with the patient under local anesthesia, and does not incur the expense of an operative procedure or hospital admission associated with laparoscopic or open surgery.
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Affiliation(s)
- N Presser
- Renal Transplant Program, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - H Kerr
- Renal Transplant Program, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - T Gao
- Renal Transplant Program, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - M Begala
- Renal Transplant Program, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - S Paschal
- Renal Transplant Program, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - D A Shoskes
- Renal Transplant Program, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - S M Flechner
- Renal Transplant Program, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
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17
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Lee HJ, Kane CJ. How to minimize lymphoceles and treat clinically symptomatic lymphoceles after radical prostatectomy. Curr Urol Rep 2015; 15:445. [PMID: 25129450 DOI: 10.1007/s11934-014-0445-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The development of a lymphocele after pelvic surgery is a well-documented complication, especially where pelvic lymph node dissection (PLND) is part of the operation. However, not all lymphoceles are symptomatic and require treatment. Most lymphoceles spontaneously resolve, and even lymphoceles that become symptomatic may resolve without any intervention. Robotic assisted radical prostatectomy (RARP) is a common operation in urology where PLND is likely to be performed in intermediate and high-risk prostate cancer patients. The rationale for performing a PLND in prostate cancer is for accurate staging and potential therapeutic benefits. However, due to potential intraoperative and postoperative complications there is still a debate regarding the value of PLND in prostate cancer. In this review, we will discuss the potential risk factors to be aware of in pelvic surgery in order to minimize the formation of a lymphocele, along with the management for clinically significant lymphoceles.
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Affiliation(s)
- Hak J Lee
- Department of Urology, UC San Diego Health Systems, 200 West Arbor Drive, # 8897, San Diego, CA, 92103, USA,
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18
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Bleomycin sclerotherapy for severe symptomatic and persistent pelvic lymphocele. Case Rep Obstet Gynecol 2014; 2014:624803. [PMID: 25105040 PMCID: PMC4109129 DOI: 10.1155/2014/624803] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 05/28/2014] [Accepted: 06/11/2014] [Indexed: 11/17/2022] Open
Abstract
Background. Pelvic lymphoceles are frequently described as a complication of pelvic lymphadenectomy performed for surgical staging of gynaecologic malignancies. Case Report. A 72-year-old woman presented with severe symptomatic and refractory lymphocele associated with persistent lower limb lymphedema and recurrent erysipelas. After four CT fluoroscopy scan guided percutaneous catheter drainages, the lymphocele complicated with infection finally resolved with two sessions of bleomycin sclerotherapy. Conclusion. Symptomatic persistent lymphoceles require treatment and nowadays the first option is interventional radiologic procedures. Bleomycin is a safe and effective sclerosing agent and therefore should be regarded as a first-line treatment choice.
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19
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Weinberger V, Cibula D, Zikan M. Lymphocele: prevalence and management in gynecological malignancies. Expert Rev Anticancer Ther 2014; 14:307-17. [DOI: 10.1586/14737140.2014.866043] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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20
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Amalou H, Wood BJ. Beware catheter breakdown during alcohol sclerosis of lymphoceles. Cardiovasc Intervent Radiol 2013; 37:850-1. [PMID: 24190637 DOI: 10.1007/s00270-013-0774-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 10/01/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Hayet Amalou
- Center for Interventional Oncology, Radiology and Imaging Sciences, National Institutes of Health, MSC 1182, 10 Center Dr., Bethesda, MD, 20892, USA
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21
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Berkoff DJ, Kanaan M, Kamath G. Fibrin glue as a non-invasive outpatient treatment for post-arthroscopic knee seromas. Knee Surg Sports Traumatol Arthrosc 2013; 21:1922-4. [PMID: 23579228 DOI: 10.1007/s00167-013-2505-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 04/03/2013] [Indexed: 11/25/2022]
Abstract
Post-surgical seromas and cysts have been reported across many surgical subspecialties including orthopaedics. Treatments include both invasive surgical approaches and more recently reported non-invasive techniques. Non-invasive approaches currently include compressive wrapping, vasopneumatic cryotherapy, and motion exercises. Persistent lesions have been treated with talc or doxycycline sclerodesis. This case presents a patient with a post-arthroscopic seroma that was treated with fibrin glue in an outpatient setting. Fibrin glue has not been reported in the post-arthroscopy outpatient setting to address cystic lesions. This case suggests a viable non-invasive treatment option for these lesions. Level of evidence V.
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Affiliation(s)
- David J Berkoff
- Department of Orthopaedics, University of North Carolina Chapel Hill, Chapel Hill, NC 27599, USA.
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22
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Moritz RKC, Reich-Schupke S, Altmeyer P, Stücker M. Polidocanol foam sclerotherapy of persisting postoperative seromas after varicose vein surgery: a series of six cases. Phlebology 2012; 28:341-6. [PMID: 22865419 DOI: 10.1258/phleb.2012.011152] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of our case series was to show the therapeutic effect and the safety of the use of polidocanol foam in ultrasound-guided sclerotherapy treatment of relatively small postoperative seromas after varicose vein surgery. METHODS We treated six patients with postoperative seromas after varicose vein surgery that were refractory to conventional treatments including compression dressings, repeated needle aspirations and manual lymph drainage. RESULTS A complete regression of the fluid collections was seen after one and two ultrasound-guided injections of polidocanol foam into the seroma cavity in two cases, respectively. Up to five treatment sessions and up to four further needle aspirations were necessary for the remaining two patients until complete regression of the seromas. No side-effects were reported. CONCLUSION This is the first case series to report of the regression of postoperative seromas after varicose vein surgery induced by polidocanol foam sclerotherapy.
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Affiliation(s)
- R K C Moritz
- Department of Dermatology--Vein Centre of the Departments of Dermatology and Vascular Surgery, Ruhr-Universität Bochum.
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Dawre S, Lamba S, H S, Gupta S, Gupta AK. The Morel-Lavallee lesion: a review and a proposed algorithmic approach. EUROPEAN JOURNAL OF PLASTIC SURGERY 2012. [DOI: 10.1007/s00238-012-0725-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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Ziętek Z, Iwan-Ziętek I, Sulikowski T, Sieńko J, Nowacki M, Zukowski M, Kaczmarczyk M, Ciechanowicz A, Ostrowski M, Rość D, Kamiński M. The outcomes of treatment and the etiology of lymphoceles with a focus on hemostasis in kidney recipients: a preliminary report. Transplant Proc 2012; 43:3008-12. [PMID: 21996212 DOI: 10.1016/j.transproceed.2011.08.060] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND The etiopathogenesis of lymphoceles remains incompletely understood. The aim of our work was to analyze the perturbations of blood coagulation process for their possible impact on the etiology of lymphoceles. Additionally we performed an evaluation of the incidence and effectiveness of treatment methods for lymphoceles. MATERIALS AND METHODS During 2004 to 2010, we performed 242 kidney transplantations in 92 female and 150 male patients. The hemostatic parameters included concentrations of: antithrombin, plasminogen, thrombin/antithrombin complexes (TAT), prothrombin products F1+2 (F1+2), d-dimers, and plasmin/antiplasmin complexes. RESULTS At 7 years follow-up 27 (11%) recipients had developed symptomatic lymphoceles, namely abdominal discomfort, a palpable mess in the lower abdomen, arterial hypertension, infection of the operative site with fever, lymphorrhoea with surgical wound dehiscence, decreased diurnal urine output with an elevated plasma creatinine, voiding problems of urgency and vesical tenesmus, and/or symptoms of deep vein thrombosis. We applied the following methods of treatment aspiration alone, percutaneous drainage, laparoscopic fenestration or open surgery. In two only patients did perform open surgery. Since 2008 we have not performed an aspiration alone because of high rate of recurrence (almost 100%) and abandoned open surgery in favor of a laparoscopic approach. Our minimally invasive surgery includes percutaneous drainage guided by ultrasound and a laparoscopic procedure with 100% effectiveness. The examined hemostatic parameters revealed decreased concentrations of TAT complexes and F1+2 in subjects with lymphocele showing positive predictive values of 33% and 41% respectively. The negative predictive values for TAT complexes and F1+2 were 14% and 10%, respectively, suggesting decreased blood coagulation activity among effected recipients. Altered blood coagulation processes may explain some aspects of the disturbances of postoperative obliteration of damaged lymphatic vessels and formation of pathological lymph collection afterward. CONCLUSIONS Perturbations of blood coagulation may be one cause for a lymphocele.
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Affiliation(s)
- Z Ziętek
- Department of Clinical Anatomy, Pomeranian Medical University, Szczecin, Poland; Clinic of Gastrointestinal Surgery, Pomeranian Medical University, Szczecin, Poland
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25
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Management of primary symptomatic lymphocele after kidney transplantation: a systematic review. Transplantation 2011; 92:663-73. [PMID: 21849931 DOI: 10.1097/tp.0b013e31822a40ef] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Management of lymphoceles after kidney transplantation is highly variable. The aim of this study was to evaluate and compare the different approaches of lymphocele management among kidney transplant recipients. METHODS MEDLINE and EMBASE were systematically searched for case studies published between 1954 and 2010. Inclusion criteria were symptomatic lymphoceles developing in recipients of deceased or living donor kidneys with specified intervention and outcome. Primary outcome was the rate of recurrence. Secondary outcomes were the rate of conversion from laparoscopic to open surgery, hospital stay, and complication rates. RESULTS Fifty-two retrospective case series with 1113 cases of primary lymphocele were selected for review. No randomized controlled trials or prospective cohort studies were located. Primary treatment modalities included were as follows: aspiration (n=218), sclerotherapy (n=155), drainage (n=219), laparoscopic surgery (n=333), and open surgery (n=188). Of the 218 cases of lymphocele managed with aspiration alone, 141 recurred with a recurrence rate of 59% (95% confidence interval [CI]: 52-67). Among those who received laparoscopic and open surgery, the recurrence rates were 8% (95% CI: 6-12) and 16% (95% CI: 10-24), respectively. The conversion rate from laparoscopic to open surgery was 12% (95% CI: 8-16). CONCLUSIONS Laparoscopic fenestration of a symptomatic lymphocele is associated with the lowest risk of lymphocele recurrence. However, the evidence base to support a recommendation for laparoscopic surgery as first line treatment is weak and highlights the need for a multicenter prospective cohort study to examine the benefits of incorporating initial simple aspiration into the management of lymphocele after kidney transplantation.
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26
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Abstract
Various collections can develop in the space surrounding a renal transplant. These collections can present at any point in time from the immediate post transplant period to several months post transplantation and can be incidental or cause significant transplant dysfunction. The use on computed tomography and ultrasound allows for the imaging characteristics of these collections and their relationship to the transplanted kidney to be easily characterized. Standard means of percutaneously accessing the collections to obtain fluid is instrumental in diagnosing their etiology. Urinomas, hematomas, seroma, lymphomas and abscesses can be seen. The management of these collections is dependent on the nature of the peritransplant collection. Optimal care of patients with peritransplant collections is best attained by considered collaboration of a multi-specialty team.
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Affiliation(s)
- Howard M Richard
- Interventional Radiology, Washington Hospital Center, Washington, District of Columbia
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27
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Mohapatra B, Kishen T, Loi KWK, Diwan AD. Retroperitoneal lymphocele after lumbar total disc replacement: a case report and review of literature. SAS JOURNAL 2010; 4:87-91. [PMID: 25802655 PMCID: PMC4365637 DOI: 10.1016/j.esas.2010.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Retroperitoneal lymphoceles (RPLs) caused by injury to the lymphatics are commonly seen after pelvic lymphadenectomy, renal transplantation, and gynecologic tumor resection surgeries. Degenerative disc disease still remains the major cause of low-back pain. Anterior lumbar spinal procedures, such as anterior lumbar interbody fusion and anterior lumbar arthroplasty, have been increasingly performed for treatment of axial back pain. RPLs, as an approach-related complication, though infrequent, have been reported after anterior lumbar spinal surgery. We report a case of RPL after total disc replacement of the lumbar spine. To our knowledge, there has been no prior report of RPL after total disc replacement managed by percutaneous aspiration only. METHODS A 49-year-old woman who underwent total disc replacement at the L4-5 level presented with a postoperative complication of RPL. The imaging findings, clinical course, and treatment are discussed, and a review of literature is presented. RESULTS The patient presented with significant abdominal swelling and discomfort at 4 weeks after surgery without any signs or symptoms of infection. Investigations showed an RPL. She was treated by multiple aspirations under ultrasound guidance. At 12 months' follow-up, the patient had no further abdominal symptoms and had gone back to her routine activities and work with significant improvement in back pain. CONCLUSIONS RPL is an uncommon complication after anterior lumbar surgery and can be managed effectively if detected and diagnosed early. Although repeated aspiration is associated with high recurrence and infection, it is a safe and minimally invasive procedure to manage RPL.
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Affiliation(s)
- Bibhudendu Mohapatra
- Spine Service, Department of Orthopaedic Surgery, St. George Hospital and Clinical School, University of New South Wales, Kogarah, Australia
| | - Thomas Kishen
- Spine Service, Department of Orthopaedic Surgery, St. George Hospital and Clinical School, University of New South Wales, Kogarah, Australia
| | - Ken W. K. Loi
- Department of Upper GI and Bariatric Surgery, St. George Private Hospital, Kogarah, Australia
| | - Ashish D. Diwan
- Spine Service, Department of Orthopaedic Surgery, St. George Hospital and Clinical School, University of New South Wales, Kogarah, Australia
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Barba Abad J, Rincón Mayans A, Tolosa Eizaguirre E, Romero Vargas L, Rosell Costa D, Robles García J, Zudaire Bergera J, Berián Polo J, Piédrola IP. Complicaciones quirúrgicas en el trasplante renal y su influencia en la supervivencia del injerto. Actas Urol Esp 2010. [DOI: 10.1016/j.acuro.2009.12.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
BACKGROUND One common complication after kidney transplantation is a lymphocele. The aim of our work was an analysis of incidence of lymphocele and the effectiveness of minimal invasive methods in the management of this complication. MATERIALS AND METHODS The examined group was consisted of 158 patients (68 female and 90 male) with end-stage renal disease who underwent kidney transplantation. RESULTS Twenty-one patients (13%) developed symptoms of lymphocele after transplantation procedure within an average time of 34 weeks. The clinical symptoms included a decrease in 24-hour urine collection, an increase in plasma creatinine concentration, abdominal discomfort, lymphorrhea with a surgical wound dehiscence, voiding problems of urgency or vesical tenesmus, febrile states, or symptoms of deep vein thrombosis. The following methods were applied with variable efficacy: aspiration with recurrence 75%; percutaneous drainage with 55%, effectiveness; laparoscopic fenestration with 72% satisfactory outcomes (1 patient presented an excessive bleeding after the procedure), and classic surgery with favorable results. CONCLUSION Percutaneous drainage guided by ultrasonic imaging should be recommended as the first attempt to cure a lymphocele. Laparoscopy is a feasible, safe technique that should be used after unsuccessful percutaneous drainage. A larger series of patients is required to confirm the superiority of minimal invasive methods to the classical approach.
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30
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Klode J, Klötgen K, Körber A, Schadendorf D, Dissemond J. Polidocanol foam sclerotherapy is a new and effective treatment for post-operative lymphorrhea and lymphocele. J Eur Acad Dermatol Venereol 2010; 24:904-9. [PMID: 20070454 DOI: 10.1111/j.1468-3083.2009.03546.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The formation of post-operative lymphocele and lymphorrhea following lymph node surgery is a potentially serious complication. Until now there has been no consensus on the most effective treatment for these complications. Therefore, the aim of our clinical trial was to compare the use of polidocanol foam sclerotherapy with compression therapy to wound drainage, in the treatment of post-operative lymphoceles. PATIENTS AND METHODS Retrospectively we analysed the data of 33 consecutive surgical patients who had developed a post-operative lymphocele between 2004 and 2008. We offered all patients drainage with compression therapy or polidocanol foam sclerotherapy with 1-day compression to treat the post-operative lymphoceles. RESULTS Altogether, 12 patients were treated with polidocanol foam sclerotherapy and 21 patients were treated with drainage alone. Secretion volumes declined from initial 50-350 ml/day to 0-20 ml/day at the end of the therapy. Lymphorrhea resolved much quicker (P < 0.0001) in patients treated with polidocanol foam sclerotherapy (median 4 days, mean value 6.4 days) than in those treated with drainage (median 31 days, mean value 30.2 days). None of the patients developed a major complication. CONCLUSION Polidocanol foam sclerotherapy is an effective and well-tolerated new treatment for patients with post-operative lymphoceles.
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Affiliation(s)
- J Klode
- Department of Dermatology, University of Essen, Essen, Germany.
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31
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Surgical complications in kidney transplantation and their influence on graft survival. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/s2173-5786(10)70059-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Safan A, Shaker H, Abdelaal A, Mourad MS, Albaz M. Fibrin glue versus martius flap interpositioning in the repair of complicated obstetric vesicovaginal fistula. A prospective multi-institution randomized trial. Neurourol Urodyn 2009; 28:438-41. [PMID: 19475577 DOI: 10.1002/nau.20754] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIMS To examine the efficacy of using fibrin glue (FG) as an interpositioning layer in the repair of complicated vesioovaginal fistulae (VVFe) as compared to the classical repair using martius flaps (Ml'). METHODS The study was conducted in 3 African institutions. Forty female patients with complicated VVFs were randomized into 2 groups. Group A were repaired anatomically using FG as interpositioning layer. Group B were repaired anatomically using MF as an interpositioning layer. FG used in this study was prepared from patients own blood. Complicating factors were recurrence, local moderate to severe fibrosis, fistula location involving the bladder neck, and or size of the fistola being more than 1.5 cm in its largest diameter. Patients were evaluated after 2 weeks, one month and 3 months postoperatively. RESULTS Thirty eight patients were evaluable as 2 patients, one from each group, lost to follow-up. Patient demographics were not different between the two study groups. The frequency of occurrence of complicating factors was not different between the 2 groups. Thirteen of group A and eleven from group B were rendered dry and that was maintained for as long as they were followed-up. The difference in the outcome was not statistically significant. CONCLUSION The use of FG as an interpositioning layer during the vaginal anatomical repair of complicated VVF appears to be of great value as an alternative to the use of MF interpositioning. Decreasing the operative time and adding simplicity to the already complicated procedure are additional values of using this procedure. Neurourol. Urodynam. 28:438-441, 2009. (c) 2009 Wiley-Liss, Inc.
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Affiliation(s)
- Ahmed Safan
- Urology Department, Ain Shams University, Cairo, Egypt
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Derweesh IH, Ismail HR, Goldfarb DA, Araki M, Zhou L, Modlin C, Krishnamurthi V, Flechner SM, Novick AC. Intraoperative placing of drains decreases the incidence of lymphocele and deep vein thrombosis after renal transplantation. BJU Int 2008; 101:1415-9. [DOI: 10.1111/j.1464-410x.2007.07427.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Król R, Kolonko A, Chudek J, Ziaja J, Pawlicki J, Mały A, Kunsdorf-Wnuk A, Cierpka L, Wiecek A. Did volume of lymphocele after kidney transplantation determine the choice of treatment modality? Transplant Proc 2008; 39:2740-3. [PMID: 18021974 DOI: 10.1016/j.transproceed.2007.08.039] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Lymphocele is a lymph collection that forms after surgery following injury to lymph nodes and vessels. The aim of the study was to perform a retrospective analysis of different treatment modalities of lymphocele in patients after kidney transplantation. MATERIAL AND METHODS A lymphocele located in renal graft area was observed in 25 of 386 transplanted patients (6.5%). Mean patient age was 45 (95% confidence interval [CI], 40 to 50) years. Mean observation time was 35 (95% CI, 27 to 43) months. RESULTS Mean time from transplantation to diagnosis of lymphocele was 29 days (range, 4 to 127). In 13 patients (54.2%), the lymphocele was symptomatic, requiring initial treatment by repeated needle aspirations or percutaneous drainage. Among 7 patients with persistence of the lesion treatment by sclerotherapy with doxycycline, povidone-iodine, and/or ethanol was successful in 4 cases who showed maximal lymphocele volume of 500 mL. Three other patients, namely, volumes of 120, 874, and 2298 mL were referred for surgery; in two cases, internal marsupialization was performed and in one case external drainage was necessary due to abscess formation. Mean time from the diagnosis to recovery in patients requiring surgical treatment was 15 (range, 8 to 24) weeks. Eleven patients with asymptomatic lymphoceles (mean volume 45 mL; range, 8 to 140) were monitored to resolution after a mean of 4 (range, 1 to 11) weeks. CONCLUSION All lymphoceles with the maximal volume exceeding 140 mL were clinically symptomatic. Initial percutaneous drainage with or without sclerotherapy was an effective method of treatment. Punctures, drainage, and sclerotherapy were not effective in patients with lymphoceles (>500 mL).
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Affiliation(s)
- R Król
- Department of General, Vascular and Transplant Surgery, Katowice, Poland.
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Pee YH, Kim KJ, Choi YG, Jeon SH, Park JD, Lee SH. Lymphocele formation after anterior lumbar interbody fusion at L4-5. Case report. J Neurosurg Spine 2007; 7:566-70. [PMID: 17977202 DOI: 10.3171/spi-07/11/566] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In this report, the authors present the case of patient with a lymphocele in the retroperitoneal area following anterior lumbar interbody fusion at L4-5. A lymphocele is a rare complication of spinal operations, especially lower lumbar spinal surgeries. The authors discuss this complicating factor and describe its features and treatments.
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Affiliation(s)
- Yong Hun Pee
- Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea
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Ziȩtek Z, Sulikowski T, Tejchman K, Sieńko J, Janeczek M, Iwan-Ziȩtek I, Kȩdzierska K, Rość D, Ciechanowski K, Ostrowski M. Lymphocele After Kidney Transplantation. Transplant Proc 2007; 39:2744-7. [DOI: 10.1016/j.transproceed.2007.08.041] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Tejwani SG, Cohen SB, Bradley JP. Management of Morel-Lavallee lesion of the knee: twenty-seven cases in the national football league. Am J Sports Med 2007; 35:1162-7. [PMID: 17351119 DOI: 10.1177/0363546507299448] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Morel-Lavallee lesion is a closed degloving injury most commonly described in the region of the hip joint after blunt trauma. It also occurs in the knee as a result of shearing trauma during football and is a distinct lesion from prepatellar bursitis and quadriceps contusion. PURPOSE To review the authors' experience with Morel-Lavallee lesion of the knee in the elite contact athlete to construct a diagnostic and treatment algorithm. STUDY DESIGN Case series; Level of evidence, 4. METHODS Twenty-seven knees in 24 players were identified from 1 National Football League team's annual injury database as having sustained a Morel-Lavallee lesion between 1993 and 2006. Their charts were retrospectively reviewed. RESULTS The most common mechanism of injury was a shearing blow on the playing surface (81%). The most common motion deficit was active flexion (41%). The mean time for resolution of the fluid collection and achievement of full active flexion was 16.3 days. The mean number of practices missed was 1.5. The mean number of games missed was 0.1. Fourteen knees (52%) were treated successfully with compression wrap, cryotherapy, and motion exercises. Thirteen knees (48%) were treated with at least 1 aspiration, and 6 knees (22%) were treated with multiple aspirations for recurrent serosanguineous fluid collections. In 3 cases (11%), the Morel-Lavallee lesion was successfully treated with doxycycline sclerodesis after 3 aspirations failed to resolve the recurrent fluid collections; return to play was immediate thereafter in each case. CONCLUSION In football, Morel-Lavallee lesion of the knee usually occurs from a shearing blow from the playing field. Diagnosis is confirmed when examination reveals a large suprapatellar area of palpable fluctuance. Elite athletes are typically able to return to practice and game play long before complete resolution of the lesion. Recurrent fluid collections can occur, necessitating aspiration in approximately half the cases for successful treatment. Recalcitrant fluid collections can be safely and expeditiously treated with doxycycline sclerodesis.
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Affiliation(s)
- Samir G Tejwani
- University of Pittsburgh, Center for Sports Medicine, Pittsburgh, Pennsylvania 15203, USA.
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Mehrabi A, Fonouni H, Wente M, Sadeghi M, Eisenbach C, Encke J, Schmied BM, Libicher M, Zeier M, Weitz J, Büchler MW, Schmidt J. Wound complications following kidney and liver transplantation. Clin Transplant 2007; 20 Suppl 17:97-110. [PMID: 17100709 DOI: 10.1111/j.1399-0012.2006.00608.x] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Advances in surgical techniques and immunosuppression (IS) have led to an appreciable reduction in postoperative complications following transplantation. However, wound complications as probably the most common type of post-transplantation surgical complication can still limit these improved outcomes and result in prolonged hospitalization, hospital readmission, and reoperation, consequently increasing overall transplant cost. Our aim was to review the literature to delineate the evidence-based risk factors for wound complications following kidney and liver transplantation (KTx, LTx), and to present the preventive and therapeutic modalities for this bothersome morbidity. Generally, wound complications are categorized as superficial and deep wound dehiscences, perigraft fluid collections and seroma, superficial and deep wound infections, cellulitis, lymphocele and wound drainage. The results of several studies showed that the most important risk factors for wound complications are IS and obesity. Additionally, there are surgical and/or technical factors, including type of incision, reoperation, and surgeon's expertise, as well as comorbidities such as advanced age, diabetes mellitus, malnutrition, and uremia. Preventive management of wound complications necessitates defining their etiological factors so that their detrimental effects on healing processes can be addressed and reduced. IS modalities and agents, especially sirolimus (SRL), and steroids (ST) should be adjusted according to the patient's co-existing risk factors. SRL should be administered three months after transplantation and ST should be tapered as soon as possible. A body mass index (BMI) lower than 30 kg/m2 is advisable for inclusion in a transplantation program, but higher BMIs do not exclude recipients. Surgical risk factors can be prevented by applying precise surgical techniques. Therapeutic modalities must focus on the most efficient and cost-effective medications and/or interventions to facilitate and improve wound healing.
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Affiliation(s)
- A Mehrabi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
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Layman RE, McNally M, Kilian C, Linn J, Roza A, Johnson CP, Adams MB, Shames BD. Does Opening the Peritoneum at the Time of Renal Transplanation Prevent Lymphocele Formation? Transplant Proc 2006; 38:3524-6. [PMID: 17175321 DOI: 10.1016/j.transproceed.2006.10.182] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND The occurrence of lymphocele formation following renal transplantation is variable, and the optimal approach to treatment remains undefined. Opening the peritoneum at the time of transplantation is one method of decreasing the incidence of lymphocele formation. The purpose of this study was to determine whether creating a peritoneal window at the time of transplantation decreases the incidence of lymphocele formation. METHODS We performed a retrospective review of renal transplants conducted at our institution between 2002 and 2004. Records were reviewed to obtain details regarding opening of the peritoneum at the time of transplant and occurrence of lymphocele. Every patient underwent routine ultrasound imaging in the peri-operative period. Graft dysfunction secondary to the lymphocele was the primary indication for intervention. Data were analyzed by chi-square. RESULTS During the initial transplant the peritoneum was opened in 35% of patients. The overall incidence of fluid collections, identified by ultrasound, was 24%. Opening the peritoneum did not decrease the incidence of lymphocele. However, more patients with a closed peritoneum required an intervention for a symptomatic lymphocele. In the 11 patients with an open peritoneum and a fluid collection, only one required an intervention. In patients whose peritoneum was left intact, 24% of fluid collections required intervention. Graft survival was equivalent. CONCLUSION Creating a peritoneal window at the time of transplantation did not decrease the overall incidence of postoperative fluid collections. However, forming a peritoneal window at the time of transplantation did decrease the incidence of symptomatic lymphocele.
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Affiliation(s)
- R E Layman
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin 53208, USA.
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Abstract
PURPOSE While hemostatic agents and sealants have long been used in the fields of surgery and urology, confusion persists about their indications for use and the optimal agent choice. We comprehensively defined and evaluated the scientific basis for hemostatic agent and sealant use in urology, and provide a conceptual framework for future research and discussion. MATERIALS AND METHODS A MEDLINE search of all available literature concerning hemostatic agents in urology was performed, including topical hemostats, anti-fibrinolytics, fibrin sealants and matrix hemostats. Select references were also chosen from the broader surgical literature. Animal studies, case reports, retrospective and prospective studies, and opinion articles were reviewed. RESULTS Hemostatic agents include a wide range of components. Recent literature has focused on fibrin sealants and matrix agents. Two main indications exist for hemostatic agents, including 1) hemostasis and 2) sealant. The best evidence for efficacy and safety exists for hemostasis, especially for nephrectomy and trauma. Newer data highlight urinary tract reconstruction, fistula and percutaneous tract closure, suture line strengthening and infertility as potential uses. Novel drug delivery and tissue engineering are areas with large clinical potential. CONCLUSIONS Hemostatic agent use is promising and yet unproven for most conditions currently treated in urology. Hemostasis continues to be the main indication, which is well established. Few trials have examined comparative efficacy among hemostatic agents and further prospective studies are needed to justify additional indications as well as determine the optimal mode of use. Minimally invasive surgery will further drive the use of hemostatic agents and sealants. Cost-effective, evidence based hemostatic agent use will continue to challenge all urologists.
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Affiliation(s)
- Y Mark Hong
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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41
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Silas AM, Forauer AR, Perrich KD, Gemery JM. Sclerosis of Postoperative Lymphoceles: Avoidance of Prolonged Catheter Drainage with Use of a Fibrin Sealant. J Vasc Interv Radiol 2006; 17:1791-5. [PMID: 17142709 DOI: 10.1097/01.rvi.0000242167.99055.31] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To review experience with fibrin-based tissue sealant sclerosis of postsurgical lymphoceles at a single institution. MATERIALS AND METHODS Fifteen patients who presented with postsurgical lymphoceles were treated with injection of fibrin tissue sealant. Procedures were performed under fluoroscopic and sonographic guidance. All lymphoceles were drained and sclerosed with a mixture of fibrin sealant and gentamicin. No drainage catheter was left in place. Postprocedural follow-up consisted of imaging and clinical evaluations. RESULTS Twelve men and three women (mean age, 52 years) were treated. Eleven patients with lymphoceles were successfully treated with one session of sclerosis. Four patients required more than one treatment (two underwent two sessions, and two underwent three sessions). Seven patients undergoing a single treatment experienced complete resolution, and the remaining patients had smaller, persistent, asymptomatic collections. Imaging mean follow-up was 114 days (range, 5-339 d); mean clinical follow-up was 487 days (range, 195-856 d). There were no periprocedural complications. CONCLUSION The use of fibrin sealant is safe and effective in the sclerosis of postoperative lymphoceles.
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Affiliation(s)
- Anne M Silas
- Division of Vascular and Interventional Radiology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, New Hampshire 03756, USA.
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Smyth GP, Beitz G, Eng MP, Gibbons N, Hickey DP, Little DM. Long-Term Outcome of Cadaveric Renal Transplant After Treatment of Symptomatic Lymphocele. J Urol 2006; 176:1069-72. [PMID: 16890692 DOI: 10.1016/j.juro.2006.04.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2005] [Indexed: 11/18/2022]
Abstract
PURPOSE Between January 1993 and December 2002 a total of 1,289 renal transplants were performed at our institution. Symptomatic post-transplant lymphocele presenting as increased creatinine and hydronephrosis of the allograft was recorded at 0.02%. Records of the 27 patients in whom symptomatic lymphocele developed and of those who underwent contralateral kidney transplant (control group) were compared to determine the long-term effects of lymphocele formation on allograft function. MATERIALS AND METHODS A total of 37 procedures for the treatment of lymphocele were performed in 24 patients. Open marsupialization (12) and laparoscopic marsupialization (3) procedures were performed as primary treatments. Two patients underwent repeat open marsupialization. Aspiration and percutaneous catheter drainage were performed as a primary procedure in 7 and 1 cases, respectively. Percutaneous nephrostomy was required in 4 cases before definitive treatment. RESULTS The mean time to development of a lymphocele was 121 days (range 35 to 631). Symptomatic lymphocele did not require treatment in 3 patients. Of 19 patients undergoing primary marsupialization, recurrence in 2 necessitated repeat surgery. However, aspiration and percutaneous drainage proved to be definitive in only 2 cases. In total 8 patients required more than 1 procedure. At a mean followup of 63 months (SD 30.3) 21 allografts continued to function with a mean serum creatinine of 152 mumol/l (SD 67.9). In the control group 3 patients experienced graft failure and mean serum creatinine was 154 mumol/l (SD 51.9). Five patients died in the lymphocele group, 2 with functioning grafts compared to 4 deaths in the control group. CONCLUSIONS Surgical marsupialization is the preferred primary treatment for symptomatic lymphocele and is associated with excellent long-term allograft outcome.
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Affiliation(s)
- G P Smyth
- Department of Urology and Transplantation, Beaumont Hospital, Dublin 9, Ireland
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43
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Ikeda T, Miyauchi Y, Nishio S, Shimamoto K, Tanji N, Yokoyama M. Primary retroperitoneal lymphocele in a pregnant woman: The first report. Int J Urol 2006; 13:445-6. [PMID: 16734869 DOI: 10.1111/j.1442-2042.2006.01335.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In a 32-year-old pregnant woman, routine ultrasonography revealed right hydronephrosis and a huge retroperitoneal mass (20 x 7 cm) containing a fluid collection. Percutaneous drainage of the mass was performed and 2 L of clear, yellowish fluid was collected. Four months following the delivery, a recurrent retroperitoneal lymphocele was identified. Six months after the delivery, laparoscopic marsupialization was performed through a 10-mm umbilical camera port and two 5-mm ports on the right side of the abdomen. A posterior peritoneal window was established by creating a wide opening in the anterior wall of the lymphocele. Subsequent ultrasonography did not indicate a recurrence of the lymphocele or right hydronephrosis over a follow-up period of 8 months.
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Affiliation(s)
- Tetsuhiro Ikeda
- Department of Urology, Ehime University School of Medicine, Toon city, Ehime, Japan.
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44
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Evans LA, Morey AF. Hemostatic agents and tissue glues in urologic injuries and wound healing. Urol Clin North Am 2006; 33:1-12, v. [PMID: 16488275 DOI: 10.1016/j.ucl.2005.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Biosurgical preparations designed to promote surgical hemostasis and tissue adhesion are now available to the urologist and are increasingly being used across all surgical disciplines. Fibrin sealant and gelatin thrombin matrix are the two most widely used bio-surgical adjuncts in urology. Complex reconstructive, oncologic, and laparoscopic genitourinary procedures are those most appropriate for sealant use. This article details the diverse urologic applications of biosurgical products in the management of urologic injuries and the promotion of wound healing.
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Affiliation(s)
- L Andrew Evans
- Urology Service, Brooke Army Medical Center, 3851 Roger Brooke Drive, Fort Sam Houston, TX, USA
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45
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Evans LA, Morey AF. Current applications of fibrin sealant in urologic surgery. Int Braz J Urol 2006; 32:131-41. [PMID: 16650289 DOI: 10.1590/s1677-55382006000200002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2005] [Indexed: 11/21/2022] Open
Abstract
Biosurgical preparations designed to promote surgical hemostasis and tissue adhesion are being increasingly employed across all surgical disciplines. Fibrin sealant is the most widely studied and utilized biosurgical adjunct in urology. Complex reconstructive, oncologic, and laparoscopic genitourinary procedures are those most appropriate for sealant use. This article details the diverse urologic applications of fibrin sealant in the management of genitourinary injuries, surgery, and complications.
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Affiliation(s)
- L Andrew Evans
- Urology Service, Brooke Army Medical Center, Fort Sam Houston, Texas 78234, USA
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Hamza A, Fischer K, Koch E, Wicht A, Zacharias M, Loertzer H, Fornara P. Diagnostics and Therapy of Lymphoceles After Kidney Transplantation. Transplant Proc 2006; 38:701-6. [PMID: 16647449 DOI: 10.1016/j.transproceed.2006.01.065] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Lymphocele incidence after kidney transplantation is as high as 18%. We retrospectively studied the therapy of 42 lymphoceles that occurred in our clinic between 1990 and 2005, focusing on possible predisposing factors for their formation and the results of several therapy variants: conservative, operative, percutaneous puncture, and laparoscopic or open marsupialization. There was no connection between lymphocele formation and the following parameters: the extent to which the iliac vessels had been prepared, the materials used for the preparation, or whether clips or ligatures were applied. Lymphoceles may originate either from the lymphatic system of the recipient or the transplanted kidney. The most sensible measures to prevent their occurrence therefore seems to be to restrict the transplant bed to the smallest permissible level with careful ligature of the lymphatic vessels in the area of the kidney hilus. Treatment for lymphoceles should start with minimally invasive measures. We use the following algorithm in our clinic: puncture to differentiate between urinoma/lymphocele and to test for bacterial infection, sclerotization (200 mg doxycyclin), and finally marsupialization if persistent. The choice of operative technique depends on the location. This algorithm resulted in a relapse rate of 9.5% during the postoperative observation period of up to 15 years.
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Affiliation(s)
- A Hamza
- Department of Urology and Transplant Center of the Martin Luther University, Halle-Wittenberg, Halle, Germany
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47
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Adani GL, Baccarani U, Bresadola V, Lorenzin D, Montanaro D, Risaliti A, Terrosu G, Sponza M, Bresadola F. Graft loss due to percutaneous sclerotherapy of a lymphocele using acetic acid after renal transplantation. Cardiovasc Intervent Radiol 2006; 28:836-8. [PMID: 16059757 DOI: 10.1007/s00270-005-0002-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Development of lymphoceles after renal transplantation is a well-described complication that occurs in up to 40% of recipients. The gold standard approach for the treatment of symptomatic cases is not well defined yet. Management options include simple aspiration, marsupialization by a laparotomy or laparoscopy, and percutaneous sclerotherapy using different chemical agents. Those approaches can be associated, and they depend on type, dimension, and localization of the lymphocele. Percutaneous sclerotherapy is considered to be less invasive than the surgical approach; it can be used safely and effectively, with low morbidity, in huge, rapidly accumulating lymphoceles. Moreover, this approach is highly successful, and the complication rate is acceptable; the major drawback is a recurrence rate close to 20%. We herewith report a renal transplant case in which the patient developed a symptomatic lymphocele that was initially treated by ultrasound-guided percutaneous sclerotherapy with ethanol and thereafter using acetic acid for early recurrence. A few hours after injection of acetic acid in the lymphatic cavity, the patient started to complain of acute pain localized to the renal graft and fever. An ultrasound of the abdomen revealed thrombosis of the renal vein and artery. The patient was immediately taken to the operating room, where the diagnosis of vascular thrombosis was confirmed and the graft was urgently explanted. In conclusion, we strongly suggest avoiding the use of acetic acid as a slerosating agent for the percutaneous treatment of post-renal transplant lymphocele because, based on our experience, it could be complicated by vascular thrombosis of the kidney, ending in graft loss.
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Affiliation(s)
- Gian Luigi Adani
- Department of Surgery and Transplantation, University School of Medicine, Udine, Italy.
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48
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Albala DM, Lawson JH. Recent clinical and investigational applications of fibrin sealant in selected surgical specialties. J Am Coll Surg 2006; 202:685-97. [PMID: 16571441 DOI: 10.1016/j.jamcollsurg.2005.11.027] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2005] [Revised: 11/21/2005] [Accepted: 11/30/2006] [Indexed: 01/06/2023]
Affiliation(s)
- David M Albala
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
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49
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Abstract
Advances have been made in every aspect of urology that strengthen the scientific underpinning of current urologic practices and that hopefully will encourage further scientific investigation into the source, mechanisms, and cure of urologic diseases. This article reviews some of the advances that have been detailed in the recent urologic literature.
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Affiliation(s)
- Chester J Koh
- Wake Forest Institute for Regenerative Medicine, Department of Urology, Wake Forest University School of Medicine, Winston Salem, NC 27157, USA
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50
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Karcaaltincaba M, Akhan O. Radiologic imaging and percutaneous treatment of pelvic lymphocele. Eur J Radiol 2005; 55:340-54. [PMID: 15885959 DOI: 10.1016/j.ejrad.2005.03.007] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2005] [Revised: 03/07/2005] [Accepted: 03/10/2005] [Indexed: 11/19/2022]
Abstract
Pelvic lymphocele, also known as lymphocyst, is a cystic structure caused by lymphatic injury usually secondary to pelvic lymphadenectomy and renal transplantation. Lymphoceles can cause morbidity and rarely mortality by compression of adjacent structures and infectious complications. This review discusses etiology and treatment options for pelvic lymphoceles including surgical and percutaneous methods with emphasis on percutaneous techniques particularly in conjunction with sclerotherapy. Percutaneous catheter drainage with sclerotherapy procedure with various sclerosing agents is described in detail. Ethanol, povidone-iodine, tetracycline, doxycycline, bleomycin, talc and fibrin glue can be used as sclerosing agents. Combination of sclerosing agents to percutaneous catheter drainage significantly improves success rate in the treatment of pelvic lymphoceles. Infected lymphoceles are usually treated solely with percutaneous catheter drainage. Percutaneous treatment can be tailored according to volume of lymphoceles. We generally prefer single session sclerotherapy and 1 day catheter drainage in lymphoceles less than 150 mL, and larger ones are treated by multi-session sclerotherapy until daily drainage decreases below 10 mL. Percutaneous treatment preferably with sclerotherapy should be considered as the first-line treatment modality for pelvic lymphoceles due to its effectiveness, widespread applicability on an outpatient basis, ease of procedure and low complication rate.
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Affiliation(s)
- Musturay Karcaaltincaba
- Department of Radiology, Division of Abdominal and Interventional Radiology, Hacettepe University School of Medicine, Sihhiye, Ankara 06100, Turkey
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